Provider Demographics
NPI:1043377633
Name:PHILLIPS DRUG COMPANY LLC
Entity Type:Organization
Organization Name:PHILLIPS DRUG COMPANY LLC
Other - Org Name:CLAYTON DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-354-7812
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:AL
Mailing Address - Zip Code:36016-0220
Mailing Address - Country:US
Mailing Address - Phone:334-775-3442
Mailing Address - Fax:334-775-7711
Practice Address - Street 1:23 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:AL
Practice Address - Zip Code:36016-0220
Practice Address - Country:US
Practice Address - Phone:334-775-3442
Practice Address - Fax:334-775-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1107383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002824Medicaid